The prognostic value of degree of pre- and post-treatment anemia in patients with advanced gastroesophageal cancers.
Authors: Malini Hu, Xin Wang, Yvonne Bach, Zeynep Baskurt, Hiroko Aoyama, Aruz Mesci, Carol Jane Swallow, Marie-Philippe Saltiel, Thais Baccili Cury Megid, Rebecca KS Wong, Jonathan Yeung, Patrick Veit-Haibach, Sangeetha Kalimuthu, Eric Xueyu Chen, Savtaj Singh Brar, Raymond Woo-Jun Jang, Elena Elimova
Journal: Journal of Clinical Oncology (2023)

e16012 Background: Anemia is common in cancer patients and cancer-related anemia has been associated with poorer clinical outcomes in various malignancies. The degree of anemia in patients receiving chemotherapy, as a prognostic factor in gastroesophageal cancers (GE), is not well understood. There have been studies looking at clinical prognostic scores and their efficacy of predicting outcomes, of which the Gustave Roussy Immune (GRIm-Score) has been seen to be most predictive of early death in GE cancers. This study aims to compare hemoglobin (g/L) values before treatment and at multiple longitudinal timepoints during treatment as a prognostic marker of overall survival (OS) and progression-free survival (PFS). It also aims to identify whether various laboratory measures in the GRIm-Score, which includes lactate dehydrogenase (LDH), neutrophil to lymphocyte ratio (NLR) and body mass index (BMI) may hold prognostic value. Methods: A retrospective analysis of 171 patients with advanced GE cancer receiving first-line palliative-intent systemic therapy at the Princess Margaret Cancer Centre in Toronto, Canada from 2011 to 2021 was performed. Laboratory data were longitudinally collected across four time points: pre-chemotherapy, at first restaging scan, at disease progression and at final blood draw at last known follow up. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method. Cox proportional hazards regression models were used to assess the association between change in hemoglobin from baseline, adjusted for LDH, NLR and BMI. Results: Mean hemoglobin value decreased with chemotherapy initiation at the first staging time point compared to pre-chemotherapy values by 10.82 g/L (-10.82, CI: -13.57, -8.07, p &lt; 0.001). On univariate analysis, patients with a hemoglobin increase of 10 g/L at their final blood draw compared to pre-chemotherapy decreased their overall risk of death by 8.50% (HR 0.915, CI: 0.843-0.993, p = 0.033) as well as their PFS by 6.90% (HR 0.931, CI: 0.873-0.994, p = 0.031). On multivariable analysis, adjusting for relevant clinical factors including LDH, NLR and BMI, an increase in hemoglobin increase of 10 g/L from baseline to final was associated with better OS (HR 0.893, CI: 0.817-0.977, p = 0.01). On multivariate analysis, an increase in LDH at progression bloodwork compared to baseline levels was associated with poorer OS (HR 1.002, CI: 1.001-1.003, p = 0.026) and an increase in NLR at final blood draw compared to baseline was associated with poorer OS (HR 1.02, CI: 1.012-1.028, p &lt; 0.001). Conclusions: Patients with metastatic GE cancers can develop treatment-associated anemia and this prognosticates a poorer overall survival. Prognostic models incorporating change in hemoglobin, LDH and NLR ratios should be considered in future clinical evaluation of metastatic GE cancers.